Studies suggest that roughly half of all Americans who suffer from chronic or recurrent pain simply cannot find a good solution. With so many Americans affected by chronic pain, USA TODAY and ABC News will examine the issue in a week-long series beginning Sunday, May 8 on ABC and Monday, May 9 in USA TODAY. The series, "The Fight Against Pain" will report on the causes of pain, the impact it has on our lives, work, family and even our mental outlook, and the new and promising treatments on the horizon.

Dr. Frederick Burgess, MD, PHD, a clinical associate professor at Brown University and president-elect of the American Academy of Pain Medicine, will answer your questions about pain and pain mangement.

Comment from USATODAY.com Host:
Welcome to the chat with Dr. Burgess on the science of pain. We will be beginning shortly.Comment from USATODAY.com Host:
Please stand by...Edmore, Mich.:
I have neck pain C-4-5 which I still have after surgery(fusion)after 7 years have passed. I had a large spur that made a U-shape in my spine, but the spur was not removed. Would this cause all of the neck, to middle of back and down my arms?

Dr. Frederick Burgess:
Sometimes surgical interventions will resolve the pain associated with nerve compression. However, in many cases nerve damage may develop that will lead to persistent pain. In these settings, there can be a state of hypersensitivity to pain, which seems to spread to an area greater than the original problem. This is not unusual. Management of this type of problem often requires a pain management expert.Pikesville, Md.:
What percentage of the untreated pain out there is due to the lack of science/knowledge/research to treat pain?

Dr. Frederick Burgess:
I am not sure I can offer you an actual percentage. It is fair to say that we have just begun to scratch the surface regarding our understanding of how the body deals with pain, and as to why it persists despite correction of the original problem.Wilkes-Barre, Pa.:
Could weakening muscles and pain
in the thighs, lower back and shoulders be associated with the drug Tri-Cor????

Dr. Frederick Burgess:
Tri-Cor is associated with the development of myositis and myopathy, which can produce pain in the thighs and elsewhere. It is often worth considering a trial period off of this medication to evaluate the problem.Forsyth, Ga.:
Why are doctors afraid to try to help us, the ones with chronic pain? They act as if we don't even know what pain is. What can we do to get the help we need to live a productive life in spite of the pain?

Dr. Frederick Burgess:
There are several reasons for the reluctance of physicians to treat chronic pain. One is that they have not been trained to. Many Doctors were trained in an era when it was considered bad practice to give medication for chronic pain. Others are fearful of the government taking away their prescribing authority, and still others are fearful of causing harm, such as with side effects, or contributing to addiction. Most all of these problems can be corrected, but progress is often slow.Glendale, Ariz.:
What can I do to relieve pain from sciatica?

Dr. Frederick Burgess:
Generally, I would recommend a through evaluation by a physician to determine the cause. Sciatica usually represents irritation of the nerves travelling down the back of your leg. There are a variety of causes. In many situations, the pain may improve with physical therapy, in others antiinflammatory injections may help, and occasionally, surgery is needed. There is no specific answer that I can give without more data on the problem.Comment from USATODAY.com Host:
Please stand by...95746:
I am diagnosed withe spondylitis and chronic fatigue, and chronic pain, for almost 10 years, me and my doctors have tried almost every medication from NSAIds, to OPIATES and muscles relaxants, etc. plus phys. therapy, accupunture, massage etc. Some of these are successful to some degree, but I still have pain at about 50% of max. Is it reasonable that I will always have some pain? What are the latest medications in pain relief?

Dr. Frederick Burgess:
It sounds as though your doctor has been trying very hard. There are a number of medications in the anticonvulsant class that can be helpful for some people; however, there is no magic bullet. In some circumstances, electrical stimulation may be helpful, including spinal cord stimulation. Also, some patients who encounter difficulties tolerating opioid medications may benefit from intrathecal drug administration of medications such as clonidine, bupivacaine, or various opioids. Zinconotide is the newest addition to the pain medication armamentarium, this is a calcium channel blocker. It must be delivered into the spinal fluid, and can have many limiting side effects. However, it can be useful when all else fails. Other approaches include trigger point injections, aquatic therapy, and mind-body techniques, such as yoga, or Tai Chi have proven useful for some patients.Comment from USATODAY.com Host:
Please stand by...The Villages, Fla.:
What current treatments and "promising new treatments" are on the horizon for reoccurring lower back pain?
Thank you
Lee

Dr. Frederick Burgess:
Low back pain is a difficult area to address, due to the fact that the pain can have multiple sources. Interesting new areas of therapy include radiofrequency ablation of the small nerves in the back, targeted injections around the spine to identify the source of the pain, which can help to determine the best method of treating the problem.Derwood, Md.:
Is it possible to address ways of combating depression while learning to adjust to pain that restricts " senior stlye" athletic activity which has been used to stay positive.

Dr. Frederick Burgess:
Depression is a commonly linked to pain. It is often hard to distinguish which is the cause and which is the effect. The management of depression is commonly approached through to methods, medication and counseling. Often adjustments in coping patterns, creating a support system, and when appropriate, the use of antidepressant medication can lead to marked improvement in both depression and pain. Many antidepressants have benefits in acting as analgesics, they can directly improve some painful problems, such as neuropathic pain. However, they can cause significant side effects, requiring careful monitoring and gradual adjustments. The best of all situations involves the prescribing of medication in conjunction with a behavioral therapy program/exercise program.Lake Saint Louis, Mo.:
I have Arachnoiditis. It was caused by dyes in Myleograms. It is permanent, incurable and disabling. I want to know why doctors are still using them.

Dr. Frederick Burgess:
Myelograms are rarely used today, except in specific circumstances. Also, the dyes that contributed to the arachnoiditis problem have been replaced with never materials that are much less prone to this problem. MRI scanning has almost made myelograms obsolete.Glen Rock, NJ..:
What do you suggest for chemo related neuropathy?

Dr. Frederick Burgess:
As with many neuropathic (nerve pain) problems, several options should be considered. First, many neuropathies will improve over time. Vitamins can be helpful occasionally, as many chemo agents actually block critical pathways involving vitamins such as folic acid. Other treatments include trials of antidepressant medications, such as nortriptyline, which have unique analgesic effects on nerve pain. Anticonvulsant medications, such as gabapentin, topiramate, or carbamezepine can be tried. In very severe resistant cases, spinal cord stimulation can be helpful.Madison,Wis.:
I am a 28 year old male with chronic low back pain. I have had a IDET, injections, denervations and nothing seems to help. What should I do?

Dr. Frederick Burgess:
Again, it is hard to give a simple answer. If not already considered, surgical interventions can be entertained, but these are by no means simple solutions and carry risk of further aggravating your problem. Medication trials with nerve stabilizing agents, such as the antidepressants or anticonvulsants are sometimes useful. One thing I always suggest that you keep in mind, is that many painful problems will gradually improve with time. The body often seems to go through cycles, some say every 7 years, but often the intensity of the pain will subside over time. In the meantime, careful medication trials and judicious use of opioid medications may help you to get through this.Tx.:
Thank you for taking my question. I have had chronic back pain in the middle of my back for some time now. At the time when it first became a problem, I had insurance through the military. The military doctor told me that I had a crack in one of my vertebrae. I didn't believe her, but I went to physical therapy anyway because it was free. Now, less than a year later, my back is in pain again. I no longer have insurance through the military, and I have no idea what I need to do. Should I consider getting a more firm mattress? Is the fact that I am overweight hurting me?

Dr. Frederick Burgess:
Without all the facts and films, it is hard to give the best answer. It sounds as though you may have had a compression fracture. Sometimes, over time, there can be some degeneration of the vertabra, and degeneration the discs above or below the injury. This can give you chronic back pain. A repeat spine film might be helpful, but an MRI study of the spine would provide better information. As far as your mattress goes, there is no right answer. The general recommendation is to use what ever is most comfortable for you. Firm mattresses help some people, but may aggravate others. Sometimes placing a board between the box spring and the mattress can help. Being overweight does aggravate matters. The more weight you carry, the more stress your joints and spine receives. Trying an exercise program, possibly swimming or water aerobics can be helpful.Nashville, Tenn.:
I am a diabetic with diabetic neuropathy and have been on oxycotin for several years now for the constant pain that is caused from the neuropathy. The oxycotin doesn't seem to be working anymore. It helped in the beginning but now it hardly does at all. Is there anything out there to ease the neuropathy pain? I have had several surgeries on my leg because the blood flow has stopped and I have no feeling in my leg or foot. I also have heart problems. The pain is so bad that I can only sleep maybe three hours a day. Is there any relief out there? Thank you for your time.

Dr. Frederick Burgess:
Chronic pain medications can be helpful, but often they do not work as well as we would like, due to the bodies natural ability to develop tolerance. Sometimes medications such as gabapentin, topiramate, carbamezepine, duoloxetine, and nortriptyline are helpful. The approach is unfortunately trial and error, if one doesn't help, I usually switch to another. Spinal cord stimulation is an approach that involves placing and electrode(s) in the area near the spinal cord. It has been very helpful for some of my patients, but it is a bit more complicated. Intrathecal medications can also be considered, that is delivery of the medicine into the spinal fluid using an implanted pump. We can often deliver several medications at once, with fewer side effects, such as fatigue. However, being a more invasive approach, it does carry some increased risk. It sounds as though you should be referred to a pain specialist. I know there are several in your area.Albuquerque, N.M.:
Are there any new treatments for fibromyalgia. I suffer from it and have not found any treatments that really help my pain.

Dr. Frederick Burgess:
Fibromyalgia is a tough one. In my experience, no one treatment seems to work well for everyone, but trying different approaches can be helpful. There is evidence to suggest that fibromyalgia may be caused by a failure of the bodies natural painkillers to function properly. Pain impulses are conducted much more freely, causing widespread pain. The general approaches include exercise within limits, I like aquatic exercise the best in a warm pool. Trials of the various nerve stabilizers previously mentioned, such as nortriptyline. Occasionally trigger point injections, but overuse can worsen the pain. Finally, opioids can be considered, but they are not a cure. A lot of new information about fibromyalgia is developing, but as of yet, we do not have the final solution.Charleston, SC:
Dear Dr. Burgess: I am a 45-year old female with a 5 1/2 year old son. Ever since I was pregnant with him I have suffered from chronic sciatic pain down my right leg and pain in the lower right quadrant of my back. Sometimes it is worse than others. It is difficult to sit for long periods of time and over the counter medications do nothing. I have to take several medications for other illnesses that I have, so I would rather not take more. I work full-time and cannot take sedating medications. I work out--do aerobics and lifting of light weights about 3 days a week. Any suggestions?

Dr. Frederick Burgess:
There can be several explanations for the source of your pain, including a disc problem, pain from the sacroiliac joint, and occasionally a stretch injury to the nerve. I think it would be important to develop a defined diagnosis, which would require a good physical assessment, possibly and MRI of the spine, and possibly and EMG/NCV study to assess the sciatic nerve. Sometimes an injection might prove very helpful, but without a defined diagnosis, it is really hard to offer a specific treatment.Indianapolis, Ind.:
What are the latest findings about migraine headaches?

Dr. Frederick Burgess:
One of the more interesting areas of study on migraines focuses on recent information that has shown the presence of a patent foramen ovale in those who suffer with migraines preceded by a visual aura. About 50% of patients experiencing migraines with aura will have a small hole in the heart. Preliminary evidence suggests that by closing this defect with a catheter device, the migraines are eliminated or greatly reduced in frequency and severity. These findings are still preliminary, but exciting. Clinical trials are under way.Comment from Dr. Frederick Burgess:
I regret that we are out of time. Thanks to all of you who wrote in. Maybe we can do this again.